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pality In which this license la to be hsued ? t() ~ . Lf so. in ~vhat capacity? ~, ~9 -
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<br /> p~licsnt ~or license I~ the s~u~e of ~ member of the governing body, or where other fsmlly relationship
<br /> ~, such member ~hall ~ot vol'on this appU~[lon.' *
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<br />S~ whether an? person other than appli~n~ h~ sn~ right, title or ln~r~t ~ the furniture, ~xturea,
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<br /> ~qulpment ~ tho premhe~ for which llce~e ia applied, ~d ff ac, ~ve name and de~a,~Jff ,
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<br />llave applicants any interest whatsoever, directly or indirectly, in any other liquor eatabliehment in the
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<br /> .... ,.....:, .. . -,,, :;~; '~ .: .,. 7.~,:.!...,. ,. ,... .~.1..;; :.:,:, ;: ,., .....:... ..... ..
<br /> Furnish the n~me and address of at least fhres bus[ness references, including one ba~k reference, .
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<br /> 1 Do you possess a retail dealer's identification card issued by the Liquor Control Commlssloner which
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<br /> Does applicant intend to cell Intoxicating liquor to other"than t'i~e'~:ousumer? /~f¢) .......
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<br /> 21. State whether applicant intends to possess, operate or permit the possession or operation of, on the
<br /> nsed premises or in any room adjoining the Heensed premises, hnY dot machine, dle~, l~'ambl[ng device ~nd
<br />
<br /> apparatus, or permit any'gambling therein ' ~)d ""
<br /> 0~1 Under what dassifieation t~ the license applied for: EXCLUSIVE I'.I~UOR STORE, DRUO STORE,
<br />] Are the premiBes now occupied, or to be occupied, by the applicant entirely ~eparate and exclusive from
<br /> other business establishment?.
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<br />2.~ State trade name to be u~ed ,D~I ~t / '~ ?~o~'--*~ ' ' '
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<br />lState name of person that will overate
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<br /> S~te whether appl[~nt has, or will be ~anted, an On-sale Liquor License in conjunction with thh
<br />Off-sale L~quor License ~nd for the 8amc premise~
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<br /> Sm~ ~het}~r applicant has, or will ~ granted, a Sunday 0n-sale Liquor License in conjunction with lhe regular
<br /> On.ale Liquor License
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<br /> Slate whether applicant has, or will be granted, an "On-sale Non-Intoxicating Malt Beverage" (3/2) Li-
<br /> License, and for
<br /> I se in conjunction with ~his Off-~ale Liquor the same premises __~
<br /> 29. Each applicant for Off-sale Liquor license must have a Federal Retail Liquor Dealer's Tax Stamp. Enter
<br /> number of said sta~np_~' -I~(~ I
<br /> I Do you iniend to deliver liquor by vehicle? ~ 0 . If so, ~tate the number of th~ Vehicle Permit
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<br /> issued for the current year by the L}quor Control Commissioner. ·
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